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FOR OFFICE USE: APPLICATiON FOR SANITATION PERMIT --------- (Complete in Triplicate) Permit No; p A _. a 7.3 --------------------------------- � This Permit Expires i Year From bate Iswed Date Issued' _ �;--r., Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the'work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: f I p k JOB ADDRESS/LOCATION _._- _C?- - --c�------ c7l/ 4F �,�L ------------ CENSUS TRACT ----- _ Owner's Name ` �.. . �_�_� J ---- ---Pha e g _ -__7_All Address -----------1-7--�•/0. -6--- _ -------�,�/I��:....�U_L----------. City - f Contractor's Name ......6-I/V'/V --- --------- Phone _b-� '_2.6' Installation will serve: Residence Apartment House❑ Commercials❑ ailer Court ;❑ Motel Ej Other - ------------------------------------------ Number of living units:___.------ Num•ber f bedrooms ----____Garbage Grinder Lot Size -�c .I -•--_--_- Water Supply: Public System and name ,, PP Y� Y �-- Character of soil to a depth of 3 feet. Sand❑ Silt.❑ Clay El Peat E] Sandy Loam .0 ClaAoam :RR-' - HardpanY Adobe ❑ Fill Material _ : If yes, type -------:=• -_ ° i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. musf fbe placed on reverse side.) y NEW INSTALLATION: (No septic tank or seepa e P � p pit permitted if public sewer is available?within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[.' Size-SX/ax-41V ----------------J - Liquid Depth ---15 -------------- -------- Capacity _!��d®--- Type1� 1_ Material_a1vCRNo.r Compartments _-_ istance to nearest: Well -------- __ `------------Foundation__04------ Prop. Line __- _ �"'- i- y� ---- LEACHING LINE [ No. of Lines -------L— Length of each line------- Total Length ____,,. -___--•- 'D' Box /-I',- J�,S Type Filter Material R-O----__Depth Filter Material - ---- � 7- -P -,- ---�--p`------ Distance to nearest: Well V�_-+_--Foundation �_ __-- -_ Property Line. ----5---------------- I SEEPAGE PIT [ Depth _I�.�_-______ Diameter - -_ Number --_ . _ Rock Filled Yes 93—No 0 Water Table Depth _____-5 _- �r ° Fr P Rack Size 1 _ o Distance to nearest: Well -------------------------Foundation ----A?-------- Prop. Line --J--- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -------------•-- Septic Tank (Specify Requirements) _ ___________ _----_-- Disposal Field (Specify Req}u,iremi en ------ law J= F - = - - a -------------------- ------- �is r----------- - - ------------ ----------------------------------------------------------------------------------- --------- _ ------------------------ - --- ----------------------f-___ -----__._- -. � �4 [Draw existing and required addition on reverse side) I hereby certify that I have prepared this application,and that the work will be done in accordance with San Joaquin County Ordinances, State Laws,?? Rules and Regulations of the San Joo4in Local Health District. Home owner or licen sed agents signbturbcertifies the:followingy I certify that in the a ance oft a work f r wF�ich this permit -i-s- issued,1 shatI hof employ any'person in such manner as to beco su t f " -7 7�t! mor man's mpensa n laws of California." i Signed ` Owner 31 i By n Title C i - ' l ------------ " ; -(, _ T " s�------- ------- ------------ [If other than owner} � �,. � D I FOR .DEPARTMENT USE ONLY �? r Ca-f---- -------------------------------- ------ [ APPLICATION ACCEPTED BY ------ _ _!_ - -------------- DATE _---�-J'-��-_-.��----_-- BU[LDI.NG P_ERMIL-ISSUER------^--v_-,.x- _ DATE ADDITIONAL COMMENTS - -- -.-_-. - _=•:-: ------- - ---- - ----------------- - -- -- - s----- --------------------------------------------------- Y ---------- ------ ------ -:a'., - --------------------------------- ------ -- - - _ -------------------- ------ Finallnsp - ___ - - ------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M